Crit Care Resusc
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The recent recognition of the myriad roles of vitamin D beyond those of bone health and calcium homoeostasis has resulted in a large body of clinical studies demonstrating an association between vitamin D deficiency and a number of adverse health outcomes. While these studies in chronic disease states have shown a strong association between vitamin D deficiency and poor outcomes, they have been unable to demonstrate cause and effect. ⋯ It is possible that low vitamin D levels may contribute to the acute multiorgan dysfunction seen in critical illness by similar mechanisms to those seen in chronic conditions. In this commentary, we briefly review the physiology of vitamin D, examine the evidence for association of hypovitaminosis with poor outcome in both ambulatory and intensive care unit patients, and debate the role of routine vitamin D supplementation in the ICU.
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Historical Article
Tetanus and the evolution of intensive care in Australia.
A review of two series of patients with tetanus from the Royal Adelaide Hospital provides a historical perspective on the evolution of intensive care in Australia. Nine consecutive severe cases presenting in 1957 constituted one of the first series published. Four patients died. ⋯ The use of nitrous oxide in the first series was abandoned owing to adverse effects on bone marrow function. Complications reported in early literature, such as fractures and myositis ossificans, presumably related to unrelieved spasm, are no longer seen. Clinicians are now likely to see the condition only if working with counter-disaster teams overseas.